Nonrandomized Comparison of Coronary Artery Bypass Surgery and Percutaneous Coronary Intervention for the Treatment of Unprotected Left Main Coronary Artery Disease in Octogenarians

Rodés‐Cabau, Josep; Deblois, Jonathan; Bertrand, Olivier; Mohammadi, Siamak; Courtis, Javier; Larose, Éric; Dagenais, François; Déry, Jean‐Pierre; Mathieu, Patrick; Rousseau, Melanie; Barbeau, Gérald; Baillot, Richard; Gleeton, Onil; Perron, Jean; Nguyen, Can M.; Roy, Louis; Doyle, D. John; Larochellière, Robert De; Bogaty, Peter; Voisine, Pierre

doi:10.1161/circulationaha.107.727099

Cited by 147 publications

(84 citation statements)

References 28 publications

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“…However a recent registry, which corrected for baseline differences, has shown a trend towards a better survival following surgery, despite the less invasive nature of PCI, and the lower initial morbidity. 17,18 There is a limited amount of data available from randomised trials on the influence of age on patient outcome after revascularisation. The BARI and SoS trial showed that survival was better with CABG compared with PCI irrespective of age.…”

Section: Discussionmentioning

confidence: 99%

Influence of age on the clinical outcomes of coronary revascularisation for the treatment of patients with multivessel de novo coronary artery lesions: sirolimus-eluting stent vs. coronary artery bypass surgery and bare metal stent, insight from the multicentre randomised Arterial Revascularisation Therapy Study Part I (ARTS-I) and Part II (ARTS-II)

et al. 2011

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Aims: We sought to evaluate the prognostic impact of age on the procedural results and subsequent clinical outcomes in patients with multivessel disease (MVD) treated either by coronary artery bypass surgery (CABG) or by percutaneous coronary intervention (PCI) with or without drug eluting stents, based on data of the Arterial Revascularisation Therapies Study (ARTS) part I and part II. The potential influence of age in determining the most appropriate revascularisation strategy for patients with MVD is largely unknown. Methods and results: Three year clinical outcome of ARTS I patients randomised to PCI with bare metal stent (BMS) (n= 600) or CABG (n= 605), and matched patients treated by PCI with sirolimus-eluting stents (SES) in ARTS II (n= 607) were reviewed according to four age quartiles. Endpoints were measured in terms of major adverse cardiac and cerebrovascular events MACCE) during hospital stay and up to three years. The frequency of female, diabetes, hypertension, peripheral vascular disease, pulmonary disease, as well as lesion complexity increased with age. At three years, MACCE free survival was comparable between patients treated by CABG or SES PCI, regardless of age quartile. The incidence of MACCE was higher among ARTS I BMS treated patients in all but the second age quartile. This was primarily related to a higher need for repeat revascularisation among BMS treated patients. However, age, which emerged as a strong independent predictor of MACCE following CABG (p<0.005), was not predictive of adverse events following PCI. Conversely, diabetes was the strongest independent predictor of MACCE among PCI treated patients (p<0.02), but didn't affect three-year outcomes following CABG. Conclusions: Age seems to influence the CABG outcome in-hospital but not PCI. PCI-SES could offer lower immediate risk in patients with MVD and comparable long-term outcome as CABG especially in older patients. The worst outcome of PCI-BMS group is primarily related to the need for repeat revascularisation. Diabetes is the most important predictor of MACCE following PCI.

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Section: Discussionmentioning

confidence: 99%

Influence of age on the clinical outcomes of coronary revascularisation for the treatment of patients with multivessel de novo coronary artery lesions: sirolimus-eluting stent vs. coronary artery bypass surgery and bare metal stent, insight from the multicentre randomised Arterial Revascularisation Therapy Study Part I (ARTS-I) and Part II (ARTS-II)

et al. 2011

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“…[147][148][149] Several studies comparing CABG to PCI, however, indicated that the advantage of CABG consists primarily of fewer repeat revascularizations. 139,[149][150][151][152][153][154][155] The study by Brener et al 156 indicates no significant mortality difference between PCI and CABG after 3 years of follow-up. Longer-term follow-up is needed.…”

Section: Recommendations For Pci For Unprotected Left Main Coronary Amentioning

confidence: 99%

2009 Focused Updates: ACC/AHA Guidelines for the Management of Patients With ST‐Elevation Myocardial Infarction (Updating the 2004 Guideline and 2007 Focused Update) and ACC/AHA/SCAI Guidelines on Percutaneous Coronary Intervention (Updating the 2005 Guideline and 2007 Focused Update)

Kushner¹,

Hand

Smith³

et al. 2009

Cathet Cardio Intervent

112

102

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“…• The EuroSCORE validated to predict surgical mortality was recently shown to be an independent predictor of major adverse cardiac events (MACEs) in studies with both percutaneous and surgical treatment arms [2,3]. Therefore, it can be used to determine the risk of revascularization irrespective of, and even before, the selection of treatment strategy.…”

Section: Scores and Risk Stratification Impact Of Comorbiditymentioning

confidence: 99%